Provider Enrollment Coordinator

Children's Hospital of Philadelphia • Philadelphia, PA

3d • $26 - $32

About The Position

This role gathers and verifies healthcare practitioner information and tracks compliance information related to provider enrollment and re-credentialing. It processes incoming applications for accuracy and completeness, verifies required licensing, certification, and other documentation, and maintains provider files and information, including service locations, rendering provider information, licensure, and ownership information.

The coordinator supports timely payer enrollment and reimbursement by preparing and submitting application packets, following up with physicians and payers, maintaining accurate provider records, monitoring credential expiration dates, and researching claims issues for the Billing Department.

Requirements

• High school diploma or GED.
• At least two years of previous experience with insurance verification, billing, and/or provider relations, or at least two years of medical insurance verification/provider relations experience.
• Working knowledge of insurance billing/provider operations within a large healthcare organization.
• Knowledge of Medicare and Medicaid policies and procedures.
• Basic proficiency with MS Word, PowerPoint, and Excel.
• Knowledge of the ECHO, NAVINET, and CAQH systems.
• Critical-thinking and problem-solving skills.
• Analytical and organizational skills.
• Ability to collaborate with stakeholders at all levels.

Nice To Haves

• Associate's degree.

Responsibilities

• Review and prepare new-hire enrollment packets for accuracy, completeness, and timely submission to payers.
• Maintain current provider information to support timely reimbursement for services.
• Follow up with physicians to request documentation needed for enrollment and re-credentialing; send renewal reminders 30 days before expiration.
• Maintain working knowledge of payer processes and updates, and keep the physician database and NPPES system accurate and current.
• Complete CAQH re-attestation every 120 days for all providers.
• Maintain files, scan credentials, monitor expiration dates, and notify administrators and the Enrollment Manager of deadlines.
• Call and correspond with payers to follow up on provider participation effective dates and numbers, with a goal of obtaining them within 60 days of the payer's receipt of an application.
• Document payer contacts and discussions and maintain copies of emails and written correspondence with third-party payers.
• Review and provide research results to the Billing Department to assist with claims issue resolution.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED